The effect of body fat mass and fat free mass on migraine headache.

BACKGROUND
Obesity seems to be associated to migraine headache. Increase in body fat, especially in gluteofemoral region, elevates adiponectin and leptin secretion which in turn impair inflammatory processes that could be contributing to migraine risk. This study was designed to assess the relationship between body composition and risk of migraine for the first time.


METHODS
In this cross-sectional study, 1510 middle-aged women who were visited in a weight reduction clinic of university were recruited. Migraine was diagnosed with HIS criteria. Body composition parameters including total fat mass (FATM), total fat free mass (FFM), truncal fat mass (TFATM), and truncal fat free mass (TFFM) was assessed using bioelectric impedance. We further assessed cardiovascular risk factors and smoking as confounding factors. To determine the real association between different variables and risk of migraine, the associations were adjusted by multivariate logistic regression analysis.


RESULTS
Elevation in fasting blood sugar, total cholesterol, LDL cholesterol, FFM, TFFM, and waist-to-hip ratio increased the risk of migraine. When the associations were adjusted for other factors, only the association between migraine and FFM remained statistically significant.


CONCLUSION
Lower FFM increased the risk of migraine in overweight and obese individuals. In the other words, higher fat free mass could be a protective factor for migraine.


de. 1In Iran,
the prevalence of overweight and obesity were 57% in women and 42.8% in men. 2 Overweight and obese individuals are at increased risk for a variety of disease including metabolic syndrome, diabetes mellitus, arthritis, gout, cardiovascular disease, and cancer.

The association between migraine and obesity has also been reported. 3,4Studies also suggest a relationship between obesity an migraine frequency and severity as well as migraine features such as phonophobia and photophobia. 1Subcutaneous fat, especially in the gluteofemoral region in women, seems to increase leptin and adiponectin secretion.Leptin and adiponectin elevation in turn impairs insulin sensitivity and mediates inflammatory process attributed to migraine risk. 5The evidences about the relationship between body composition (fat mass/fat free mass) and migraine are rare.Current study was designed to assess the relationship between migraine and body composition in overweight and obese individuals.


Iranian Journal of Neurology


Anthropometric measurements

Body weight was measured to the nearest 0.1 kg using Seca 755 Dial Column Medical Scale.Height was measured to the nearest 0.1 cm using a standard stadiometer.Body mass index (BMI) was calculated by dividing weight in kilograms by height in square meters.BMI ≥ 25 was defined as overweight and BMI ≥ 30 was defined as obesity.Waist circumference was measured by the standard tape meter at the maximal narrowing of the waist from anterior view.Hip circumference was measured at the point of maximal gluteal protuberance from the lateral view.Waist-to-hip ratio was calculated through dividing the waist circumference by hip circumference.

Body composition was measured by

not to eat or drink wi
hin 4 hours, and not to exercise within 12 hours of the test.

Participants were asked to void within 30 minutes left to the test (with empty bladder) and had minimal consumption of diuretic agents.

The body composition analyzer measured total fat mass (FATM), total fat free mass (FFM), total body water, and segmental analysis for fat mass and fat free mass in trunk.


Cardiovascular risk factor assessment

Fasting blood sample was obtained to measure fasting blood sugar (FBS), total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL).

perglycemia was defined as h
ving FBS ≥ 126 mg/dl.The patient was diagnosed with dyslipidemia if he/she had serum levels of total cholesterol ≥ 240 mg/dL or LDL ≥ 160 mg/dL or HDL ≤ 40 mg/dL or was taking lipid lowering drugs.

Blood pressure was measured for participant in a sitting position after a 10-minute rest, on the upper arm, using mercury sphygmomanometer (Richter™).Hypertension (HTN) was defined as having systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg.Smoking status was assessed through self-report.Smoking in past 6 months was defined as active smoking.


Statistical analysis

For descriptive analysis of quantitative data, the me n ± standard deviation was used.For qualitative data, frequency percentage was reported.To evaluate the association between migraine and risk factors odds ratio (OR) with 95% confidence interval (CI) was used.Finally, we used multivariable logistic regression analysis to control the effect of confounding factors.

To determine th cut-off value of FATM, FFM, truncal fat mass (TFATM), and fat free mass (TFFM), the receiver operating characteristic (ROC) curve analysis was used with respect to BMI ca

gories (BMI ≥ 30 kg/m 2 ).Cut-off poin
s were considered as the number which represented the maximum of the square of specificity plus sensitivity.Statistical Package for the Social Sciences, vers on 17.0 (SPSS, Chicago, IL, USA) was used to analyze the data.


Results

Of the 1510 participants, a total of 320 (21.2%) were diagnosed with migraine.The participant's characteristics were summarized in table 1.The independent v riables were then categorized.For categorizing FATM, FFM, TFATM, and TFFM, cutoffs by ROC curves were applied (Figure 1).

The comparison of participants' characteristics between migraineurs and non-migraineurs were presented in table 2. Higher ratio of fat mass/fat free mass, truncal fat mass/truncal fat free mass, and volume of truncal fat mass were significantly ass

iated with elevated r
sk of migraine.Except for FFM, the association between all the variables and migraine were attenuated after logistic regression analysis (


Discussion

In healthy overweight and obese individuals, elevation of total cholesterol, LDL-cholesterol, FBS, waist-to-hip ratio, FFM, and TFFM increased the risk of migraine.After adjustment, the only significant association was etween migraine and FFM.At the tissue level, FFM focuses on skeletal muscle, bone, blood, and visceral organ.The main component is skeletal muscle. 6 the best of our knowledge, this is the first time that the relationship between body composition parameters and migraine was assessed.An energyrestricted diet in combination with aerobic and anaerobic exercises would reduce fat mass while preserving fat free mass. 7Therefore, restricting calorie inta

and hav
ng an exercise program can reduce the risk of migraine in overweight an obese women.Previously, large population based studies assessed the association between physical activity level and migraine.In line with our hypothesis about the effect of exercise on the risk of migraine, Mild busch et al. in a study on 1260 adolescents concluded that there is a 3.4 fold risk of migraine in physically inactive individuals.They included migraine and tension-type headache, using the criteria of International Classification of Headache Disorders, 2 nd edition (ICHD-II). 8In the HUNT study, among a subset of 5847 adolescents, physical inactive, smoker, and overweight individuals were 1.4 fold more likely to suf er from recurrent headache (tension

ype or migr
ine).Subjects with low physical activity level had 1.2 times greater risk for recurrent headache.In another large cross-sectional study of 46648 individuals, inactivity was associated with higher incidence of selfreported non-migraine and migraine headache. 9oreover, some studies have assessed the therapeutic effects of aerobic exercise programs in migraineurs.Varkey et al. study has focused on increasing oxygen uptake and it was well tolerated. 10vidences suggest that aerobic exercise increase beta endorphin secretion which may subsequently increase pain threshold.

Exercise is also associated with an increase in fat free mass.According to our findings, lower level of fat free mass was associated with increased risk of migraine.Therefore, physical activity can also reduce migraine risk by increasing fat free mass.

A number of limitations should be considered in interpretation of our results.First of all, our study population was limited to overweight and obese middle-aged women.Therefore, the results may not be expanded to other age-groups, men, or normal weight individuals.We chose overweight and obese women because they are more prone to migraine than men and normal weight subjects.Second, since this study was cross-sectional, although we adjusted the odd ratios for the most potential confounders, we cannot exclude the other possible confounding factors.Third, we just evaluated the association between body composition parameters and migraine.The association between body composition and other types of headache is remained to be evaluated.


Conclusion

All together, the findings of the current study suggested that the decrease in fat free mass may increase the risk of migraine in overweight and obese individuals.Further studies are warranted to evaluate the effects of fat free mass changes on migraine severity.

Table 3 ). http://ijnl.tums.ac.ir 3 JanuaryTable 1 .
31
Characteristics of overweight and obese women participated in the study, categorized by having or not having migraine headache Receiver operating char